Hepatic echinococosis complicated with cavernous degenration of portal vein

Medical

Cavernous Transformation of the Portal Vein (CTPV) is a rare condition with various etiologies and diverse clinical presentations. It occurs with long-standing portal vein thrombosis (PVT) which causes portal hypertension and an occlusion of the portal vein leading to the development and dilatation of multiple small vessels in and around the re-canalizing main portal vein . It has been found to occur commonly in patients with healthy livers with chronic non-cirrhotic and non-tumoral PVT. Yet, the causes of CTPV are unknown. The main clinical presentations are gastroesophageal variceal bleeding and hematologic abnormalities due to the effects of the collateral vessels resulting in an enlarged spleen and the development of porto-systemic collaterals. However, the diagnosis of CTPV is very rarely made on an adult with signs and symptoms of obstructive jaundice. Abdominal ultrasonography, color Doppler ultrasonography, computated tomography angiography (CTA), and magnetic resonance imaging (MRI) are used to confirm its diagnosis. We report a case of a male adult in whom the diagnosis of CTPV was made during the initial workup for a hepatic mass. The symptoms that led us to this rare diagnosis were hyperbilirubinemia and an extrinsic mass compressing on the stomach and the small bowel without any signs of portal hypertension. Although the patient presented with anemia, no sources of bleeding were found, including the presence of esophageal varices.

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